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Submitted
Abstract
Predicting Vesicourethral Anastomotic Leakage: Identifying Risk Factors in Laparoscopic and Robotic Prostatectomy Patients
Moderated Poster Abstract
Clinical Research
Oncology: Prostate
Author's Information
2
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Thailand
Ponglert Kittirattanapaiboon sk135.james@gmail.com Faculty of Medicine, Chiang Mai University Division of Urology, Department of Surgery Chiang Mai Thailand *
Akara Amantakul akara.amantakul@cmu.ac.th Faculty of Medicine, Chiang Mai University Division of Urology, Department of Surgery Chiang Mai Thailand -
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abstract Content
Vesicourethral anastomotic leakage (VUAL) is one of the short-term complications after laparoscopic (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP), often requiring prolonged catheterization and extended hospitalization. Intraoperative bladder fill tests and postoperative cystography are standard detection methods. This study aimed to assess the safety of omitting postoperative cystography and identify VUAL risk factors.
A retrospective cohort study was conducted on 205 prostate cancer patients who underwent LRP or RALP between January 2007 and December 2024. Data collected included demographic characteristics, intraoperative variables (surgical approach, estimated blood loss, operative time, prostate weight, intraoperative bladder neck reconstruction, and intraoperative leakage during bladder fill testing), and postoperative variables (pathological T stage, pathological Gleason score, and length of hospital stay). Statistical analyses were performed using Exact McNemar's test, Fisher's exact test, Student's t-test, Mann-Whitney U test, and logistic regression.
Postoperative cystography detected VUAL in 8.8% of patients, associated with longer hospital stays (p<0.001). A negative intraoperative bladder fill test reliably predicted the absence of postoperative leakage (p=0.690). Significant independent risk factors for VUAL were intraoperative leakage and estimated blood loss >300 ml. Moreover, larger prostate gland volume (greater than 45 grams) and a history of smoking were observed to increase the risk of VUAL, although these associations did not reach statistical significance.
The omission of postoperative cystography appears to be safe in patients with negative intraoperative bladder fill test results. However, postoperative cystography is recommended for patients exhibiting intraoperative leakage and/or estimated blood loss exceeding 300 mL. Consideration for postoperative cystography should also be given to patients with large prostate glands or a smoking history, given the observed trend toward increased risk.
Vesicourethral anastomosis leakage, Laparoscopic Radical Prostatectomy, Robotic-Assisted Laparoscopic Radical Prostatectomy
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Table 1: Characteristic of patients
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Table 2: Univariable and multivariable analysis to identify risk factors for VUAL in both LRP and RALRP (n = 205)
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Table 3: Comparing Leakage status between Intraoperative Bladder Fill Test and Postoperative Cystography in dependent population using Exact McNemar’s test
 
 
 
 
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Presentation Details